MEDICARE: CRAIG J RUSKIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	ME63210	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063411064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG J RUSKIN M.D.

Provider Business Mailing Address
First Line	:	661 E ALTAMONTE DR
Second Line	:	SUITE 120
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-5105
Country	:	US
Telephone Number	:	407-331-9595
Fax Number	:	407-331-8484

Provider Business Practice Location Address
First Line	:	661 E ALTAMONTE DR
Second Line	:	SUITE 120
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-5105
Country	:	US
Telephone Number	:	407-331-9595
Fax Number	:	407-331-8484

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	02/16/2011

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